AGRAPHIA. — True agraphia almost always occurs as a result of a lesion of the foot of the second left frontal convo lution or of the suhcortical fibres there from. Agraphia is generally found, how ever, associated with some form of motor aphasia, rarely existing alone.
Case of a woman, who, at 41, had an attack of right hemiplegia involving the tongue. She lest the ability to write Series of perimeter charts in a ease of complete agraphia and almost complete word-blind ness, with right-sided bilateral temporal hemianopsia. (The black area represents the blind parts of the fields.) Chart I represents the fields of vision on Nov. 17th. Chart 2 represents the fields of vision on Nov. 24th. Chart 3 represents the fields of vision on Dec. 1st. Chart 4 represents the fields of vision on Dec. Sth. Chart 5 rep resents the fields of vision on Dec. lath.
(Byrom Bramwell.) spontaneously and from dictation. hut could copy. There was no word-deafness nor word-blindness. When 55, a second attack of hemiplegia occurred, this time of the left side, with complete loss of speech. A third and fourth attack oc curred six years later, and death eight years afterward, at the age of 69. At the necropsy areas of softening were found in the left hemisphere (1) at the posterior extremity of the second frontal and (2) in the middle portion of the sec ond frontal on the right side; (3) at the anterior extremity of the third frontal and posterior portion of the third fron tal, extending into the ascending frontal (4) at the foot of the ascending fron tal and parietal and (5) in the pos terior portion of the ascending parietal. Two additional areas of roftening were found at the base of the right hemi sphere, but these, with No. 3, were sup posed to have given rise to no symptoms. Nos. 2 and 4 caused symptoms of bulbar paralysis, No. 5 the left hemiparesis, while No. 1—the lesion at the posterior portion of the second left frontal—was considered responsible for the peculiar form of agraphia. Charcot and Du breuihl (Annual, '94).
The above or similar eases reported do not prove that the centre for written language lies in the second left frontal. It is very difficult to isolate and localize a pure motor agraphia. Against the hypothetical existence of a centre for writing in the above case is the fact that no one could write with the feet as well as with the hands, although it can be conceived that a higher motor centre for writing may exist, connected with the lower centres for the hand and foot either of which may govern the periph eral mechanism of writing. The same
type of agraphia had accompanied motor aphasia in this ease, in cases in which the lesion was of Ilroca's convolution. D6jerine (Annual. '94).
Case of a man of 26 who had been violently pushed, the head striking for cibly against edge of a dresser. Injury was over right parietal eminence. For two or three days afterward showed the ordinary symptoms of concussion. Later he could not recognize letters or figures, nor name most things at sight, though he eould point out anything named, and, a name being suggested, he repudiated the wrong one on every occasion. Spon taneous writing was confined to his own name, which he wrote quickly. He could neither write from dictation nor read aloud. He could copy, but could not transfer printed into written, nor written into printed, characters. The field of vision was normal in both eyes. No hemianopsia was present. Gradually the patient improved. Not until the man was able to read aloud was there any sign of understanding any written question. He could read aloud a few combinations of figures, such as 100 and 1897, and write 1897 down in well-formed figures, but he could not recognize indi vidual figures at sight. nor put them clown from dictation. This suggests the possibility of there being a distinct group of cells the function of which is to store combinations of figures which might be called the visual figure-combination centre as distinct from the visual figure centre. Four divisions of the visual nerve-centre might be made: (a) one for letters; (b) one for numerals; (c) one for words; (d) one for combinations of figures. One would naturally expect only two subdivisions: (a) a centre for letters and numerals; (b) a centre for words and figure-combinations. But Hinshelwood has noted that there are cases in which the visual memory for letters is entirely lost, while that for figures is intact, or in which the visual word-memory only was affected. C. Mac Vicar (Scottish Med. Jour., Nov., '98).